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Hospital Boards and Quality Dashboards

Abstract

Introduction: Dashboards/scorecards have emerged as a vital tool for hospital leaders who are interested in promoting quality improvement (QI) within their institutions. As part of a collaboration between the University of Iowa College of Public Health, Department of Health Management and Policy (HMP) CareScience, and the Centers for Medicare and Medicaid Services (CMS), researchers analyzed a set of hospital board performance measurement summary reports (dashboards) and their relationship to leadership engagement and QI in 9 states across the United States. The goals were to assess the content and composition of hospital board dashboards, to examine how board dashboards are created and used by various constituencies in the hospital, and to explore the relationship between dashboards and hospital performance to identify, in a preliminary way, those structures and processes related to dashboards systems that most directly influence QI.

Methodology: Of the 139 hospitals that supplied their dashboards, 109 completed an internet-based Dashboard Implementation Survey that addressed the development and utilization of dashboards in the hospitals. The survey instrument was developed and pretested by a group of survey experts and researchers from CMS, CareScience, and HMP. The analyses of the dashboard content and implementation were linked to hospital performance data from CareScience and Solucient, 2 healthcare performance measurement system vendors with expertise in performance data analysis, modeling, and reporting that collaborated with HMP and CMS in this study. Both measurement systems are used to rank hospitals on a composite of measures. The systems use hospital-specific, risk-adjusted results for inpatient mortality, complications, patient safety, adverse outcomes, length of stay, and other selected measurements to represent a broad indicator of hospital performance.

Findings: The Dashboard Implementation Survey showed that there are some commonalties in the way that dashboards are created and used. First, the majority of hospitals in the study include Hospital Compare measures in their dashboards. Second, dashboards typically are shared widely within the organization, although with differing frequencies. Third, dashboard content derives from multiple constituencies, although its development is generally directed by the executive and by the QI staff. Finally, dashboards are usually geared more toward the creation of general awareness and focus than used for operational and performance management. The patterns revealed that greater hospital quality was linked to shorter, more focused dashboards, active use of dashboards for operations management, and strong influence of board quality committees in dashboard content and implementation.

Discussion and Recommendations: This study found much variation in dashboard content and in the implementation practices associated with them. The suggested relationship of dashboard content, development, and implementation practices to observed hospital performance is worth noting. Further research relating these preliminary findings to quality performance would enable the identification of characteristics of dashboards that are most useful in supporting hospital leadership in its QI activities.

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